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tions of the Canadian Hypertension Society (CHS)' in .... lisinopril and quinapril) are approved in Canada for the ...... Arch Intern Med 1991; 151: 1769-1776. 65.
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Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of essential hypertension

Richard I. Ogilvie, MD, FRCPC; Ellen D. Burgess, MD, FRCPC; Jean R. Cusson, MD, FRCPC; Ross D. Feldman, MD, FRCPC; Lawrence A. Leiter, MD, FRCPC; Martin G. Myers, MD, FRCPC

Resume: Les auteurs examinent des preuves recentes au sujet du role des diuretiques thiazidiques et des B-bloquants dans la monotherapie de l'hypertension essentielle. Les a-bloquants, les medicaments a action centrale, les inhibiteurs de l'enzyme de conversion de l'angiotensine et les antagonistes du calcium sont egalement debattus. Des recommandations sont faites sur le traitement pharmacologique de l'hypertension non compliquee (les diuretiques thiazidiques ou les B-bloquants demeurent les medicaments de choix) et de l'hypertension chez les patients atteints ou a risque de maladie cardiovasculaire, de lesion des organes cibles, de maladie pulmonaire obstructive chronique, d'asthme et de goutte. Le traitement pour des groupes specifiques de patients est egalement considere.

methods of critical appraisal of the research are described in more detail in the first' and second3 articles in this series and in the article by Sackett.6 Table 1 shows the rating system applied to most of the journal articles evaluated by the expert panel. The recommendations were graded according to the level of evidence available (Table 2).

Initial monotherapy for uncomplicated essential hypertension Thiazide diuretics andfl-blockers

Efficacy: The 1988 Canadian consensus conference the pharmacologic treatment of hypertension reviewed major clinical trials7"12 of thiazide diuretics and B-blockers in monotherapy, in combined therapy or as part of multiple drug therapy; it recommended these drugs for initial therapy for uncomplicated essential hyT he pharmacologic treatment of essential hyper- pertension. The trials were included in a recent metatension continues to evolve as new agents are in- analysis of the effect of antihypertensive therapy on troduced and additional clinical trials are cerebrovascular accident (CVA) and coronary heart discompleted. This article reviews the 1989 recommenda- ease (CHD), which concluded that drug treatment retions of the Canadian Hypertension Society (CHS)' in duced the incidence of CVA by 42% and of CHD by the light of this new information. The new recommenda- 14% over 2 to 3 years.'3 The authors speculated that altions are an addition to those previously published on the though the benefits of such therapy for CVA are nonpharmacologic management of blood pressure, achieved in this relatively short time, only 50% of the which are unchanged.2 When a diagnosis of hypertension expected CHD events were prevented. Since 1988 three studies on hypertension in older has been made,3 the goal of reducing the diastolic blood groups have confirmed the efficacy and safety of diuretpressure to less than 90 mm Hg is unchanged.4 This report was prepared by an expert panel ap- ics and B-blockers and have shown a marked and signifpointed by the CHS. It has been reviewed in plenary ses- icant reduction in the risk of CVA.'F'6 (These trials are sion, and its recommendations were approved by secret discussed in more detail in the next article in this ballot at the 1992 consensus conference of the CHS. The series.17) They have confirmed the finding of an earlier on

Reprint requests to: Dr. Richard L. Ogilvie, The Toronto Hospital, Western Division, 399 Bathurst St., Toronto, ON M5T 2S8